Pathophysiology and management of pain

Pain is the commonest sympton of disease and as such has a most prominent position in the diagnosis of disease. Most doctor training curricula emphasise this aspect of pain (that is; its diagnostic value) but little attention is given to the individual's cultural and psychological make-up that influence its severity and the indiviudal's ability to cope with it. For this reason; management of pain has not been given the attention it deserves and common treatment regimes and plans appear ritualistic and hardly ever give sufficient consideration to the patient's needs. The development of chronic pain requires more detailed management plan and all aspects of the patient should be considered including: the clinical; aetiological and pathological diagnosis; psychosocial make up; emotional and motivational background; the expected duration of illness; othere intercurrent illnesses and other concomitant treatments. The management of the hysteriacal patient must essentially be different from that of a hypochondriac. The mechnaisms underlying the pain; whether in the peripheral sensory apparatus or the cental circuitry subserving pain; the neural pathways of pain; the inherent pain mechanisms; and the endogenous pain relieving mechanisms; need to be understood ideally before formulating a treatment plan. The role played by local and peripheral factors at the site of injury; by nerve growth factors; cytokines and others in the development of physiological and anatomical recruitment; so central to chronic pain; are also fundamental towards management; especially in the exploration for ways of preventing the development of chronic pain. Exploitation of these mechanisms and the effective use of drugs appropriately and in the right doses supportyed by physical and psychological methods would go a long way in alleviating the problem of unecessary pain so common in clinical practise. This communication deals mainly with the pathophysiological mechanisms in the development of chronic pain and possible approaches to its management

Hepatic artery ligation in hepato-cellular carcinoma

In carefully selected patients H.A.L is the best surgical of palliation of this disease in our experience. It is relatively simple and the post operative complications are neglible. It is emphasized that with early detection of the tumour more cases could benefit from this procedure